Academic journal article Journal of Singing

Voice Disorders in Teachers: Examining the Problem and Evaluating Prevention

Academic journal article Journal of Singing

Voice Disorders in Teachers: Examining the Problem and Evaluating Prevention

Article excerpt


TEACHERS FREQUENTLY STRAIN THEIR VOICES in the classroom, placing them at increased risk of developing vocal dysfunction, or dysphonia. Vocal dysfunction is an occupational risk for all teach-ers; however, it is an especially important concern for teachers of singing.1 Miller and Verdolini established that teachers of singing experience more episodes of dysphonia during their career and are more likely to seek medical intervention for vocal dysfunction compared with nonteachers.2 When compared with teachers of other subjects and grade levels, performing arts teachers are affected more often by chronic voice dysfunction. Chronic vocal stress can lead to serious, permanent health problems that affect a teacher's ability to teach and quality of life.3

Teachers account for the majority of the 5-10% of the United States workforce described as "heavy occupational voice users."4 Recent large cohort studies have revealed that high effort and high volume voice use in the classroom places all teachers at increased risk for developing vocal dysfunction. In a study of over 1,000 teachers, nearly 60% experienced vocal dysfunction that interfered with the ability to communicate.5 Another large study found teachers to be disproportionately affected by dysphonia compared with non-teachers, suggesting voice disorders in teachers are widespread.6

A voice disorder is present whenever a voice does not function, perform, or sound as it usually does, interfering with communication. Symptoms of voice disorders include hoarseness, breathiness, weakness, strain, pain, tightness, ache, discomfort, dryness, and other symptoms. Such symptoms can be caused by various abnormalities that include chronic laryngitis, vocal fold nodules, other benign and malignant masses, laryngoesophageal reflux, paresis, endocrine or pulmonary dysfunction, voice abuse or misuse, glottal insufficiency, and hyperkinesias, among others. Persistent vocal strain can lead to damage of vocal tissue, adversely affecting professional voice users, including teachers.7

Despite the fact that dysphonia is not life threatening, Smith et al. found the impact of voice dysfunction to be similar to that of an individual with a severe medical condition.8 Quality of life questionnaires compared with previously published data revealed that vocally disordered patients suffered equally or more than patients with rheumatoid arthritis, hemodialysis treatments, or a prior bone marrow transplant.9 Such a significant impact warrants a complete understanding of dysphonia.

This information is especially useful to all education professionals. Improving awareness of voice disorders will increase identification of developing vocal dysfunction and encourage teachers to access effective care crucial to preventing permanent damage. This review presents the current understanding of vocal dysfunction in teachers by defining the frequency of voice disorders, uncovering specific risk factors and patterns associated with the development of voice disorders, and evaluating potential preventive and treatment strategies.


Vocal dysfunction has long been reported as an occupational hazard for teachers. Compared to the general population, voice disorders affect teachers more often due to excess vocal strain and lack of vocal training.10 Two controlled studies reported that teachers were nearly twice as likely to experience vocal dysfunction over the course of their career compared with nonteachers.11 In another report comparing dysphonia in teachers and nonteachers, the former were more likely to experience vocal weakness, fatigued voice, and forced or increased effort. These symptoms led to a higher incidence of scratchy, achy, and uncomfortable phonation.12 Long periods of high effort phonation and lack of vocal hygiene knowledge are associated with increased incidence of dysphonia.13

In a study of teachers with self-identified dysphonia, intense vocal demand was reported by over 80% of teachers, and more than half felt vocal dysfunction negatively impacted their job performance. …

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